“Small Fry Basketball Camp” CAMP FOR KIDS Ages 4-6

Rawson Gym Enter door #4 M-T-W-TH August 9-12 6:00-6:50 pm Code PG401.417 $24R/$34NR The hoops are lower and the balls are smaller. Players will learn the fundamentals of the game including shooting, passing, and rules. Parents are Welcome.

Instructor: Matt Moen

REGISTRATION FORM

MAIL REGISTRATION: WALK-IN REGISTRATION

South Milwaukee Recreation Dept. South Milwaukee High School

901 15th Avenue 901 15th Avenue

South Milwaukee, WI 53172 Park on east side of the high school

417-766-5081 or 414-766-5082 Enter through Door #24

www.smrecdept.org

Family Last Name:______________________________ First Name:_________________________________________ Address: ______________________________________ City: ___________________________ Zip:________________ Home Ph:(____) _______ -________ Business Ph:(____)-_______ -__________ Cell Ph:(____) _______ -___________ E-Mail Address: ____________________________________________________________________________________ I, the undersigned do hereby agree to allow the individual named herein to participate in the activities indicated. I am aware and understand there may be potential risk inherent with participation in any recreation activity, and that the School District of South Milwaukee does not provide accident insurance and cannot assume responsibility for injury to any participants in the recreation programs. I further understand the eligibility requirements for the program as stated in the department brochure or flyers and that fees transfers and refunds are not permitted. I also agree to allow publication of any photos taken of me at any program, event, or facility of the South Milwaukee Recreation Department. I have read and fully understand the concussion protocols for athletes and will turn in the Concussion Parent/Athlete Agreement Form at the time of registration. This form and additional concussion information is available online at www.smrecdept.org. You may also pick up the form in the Recreation Dept. Office. ________________________________________ ____________________________________________ Participant/Parent/Guardian Signature Date

Participant Name M/F Date of Birth Grade Activity Name Activity Code Fee

Special Information (i.e. medical, physical, allergies:):______________________________________________________

Total: $________ Check #________ Cash________ Money Order________

Make checks or money order payable to the South Milwaukee Recreation Department

Please Circle the Youth T-Shirt Size if one is given as part of the registration XS S M L XL

Thank you for taking the time to register!